While the study provides some insights into the complexity of nurse staffing, there are many gaps in the report.

The study recommends:

Improving nurse workforce data collection and analysis

Considering implementation of a public reporting system for hospital staffing levels

Calling for hospital consideration of:
– Consistency of nurse staffing during off-shifts (nights, weekends, holidays)
– Improving the nurse work environment. Increasing the percent of nurses with a Bachelor’s of Science Degree in Nursing

Extending the whistleblower protection law to include nurses

Message Points:

Overall:

Pennsylvania hospitals are as unique and diverse as the communities they serve. Hospitals strive every day to provide high-quality patient care, and every health care practitioner they employ serves an important role in achieving that mission. Nurses are critical members of the health care team. They play an integral role in coordinating and advancing quality patient care, preventing harm, and saving lives.

Engagement of front-line nursing staff has been paramount to the success of the three-year Pennsylvania Hospital Engagement Network quality and patient safety initiative, in which improvements were made in every project category to reduce harm and hospital readmissions.

The study draws conclusions from data captured during the 1990s and 2006, and does not consider or address the very dramatic and significant changes in health care during the past ten years. These changes are the result of the Affordable Care Act implementation, the shift from inpatient care to outpatient and preventive care, greater use of advance practice professionals, and quality and safety advances.

The section about the 14 states that have nurse staffing statutes or regulations has no data on outcomes or quality from those states to reflect that these 14 states have higher quality than do states without these requirements. The section is entitled, “Policy Evidence,” but no evidence is provided.

The report provides limited quality data. The report includes some data from HAP’s quality report reflecting that Pennsylvania hospitals and health systems have reduced infections, pressure ulcers, other harm, and readmissions during the last three years; and how front-line nursing staff has been engaged in improving patient safety.

While there is demographic data about nursing school graduates from the three levels of nursing, there is:
– No data about the nurse license pass rate by type of education
– No data about the capacity of Pennsylvania’s existing nursing education programs
– No information on the articulation agreements that enable community college and hospital school of nursing graduates to go and secure their baccalaureate degree

There are no perspectives included from nurse leaders, who are the professionals held accountable for nurse staffing.

References to older survey data about excessive overtime fails to incorporate data that showed the use of overtime was a far greater problem in the state-owned inpatient psychiatric and correctional facilities and nursing homes, and was not a significant problem in general acute care hospitals.

There is no information or data about Pennsylvania’s Magnet-designated hospitals, which would have illuminated the study’s assertions regarding the nurse work environment.

The report suggests that Pennsylvania should extend the whistleblower protection law to include nurses. This protection already is in place.
– Pennsylvania nurses can report safety issues and have whistleblower protections
– Pennsylvania nurses can file complaints about quality with the Department of Health and have whistleblower protections

HAP Position:

The study offers only the beginning of a much needed, more thorough discussion about nurse workforce data collection and analysis that can assist health care providers, nursing professionals, and public policymakers in supporting Pennsylvanian’s needs for quality nursing care.

Download a copy
of the Joint State Government Commission Study on Nurse Staffing Key Messages